Diffuse alveolar hemorrhage (DAH) is a rare but serious complication of systemic lupus erythematosus (SLE).
Risk factors:
(1) active lupus with systemic disease and high SLEDAI score, possibly as an acute flare
(2) lupus nephritis
Presentation:
(1) hemoptysis (absent in a third to half of patients)
(2) dyspnea
(3) cough
(4) hypoxemia
(5) fever
(6) pulmonary infiltrate
(7) unexplained fall in hemoglobin and hematocrit
The diagnosis requires exclusion of other causes of pulmonary hemorrhage, especially pulmonary embolus and hemorrhagic pneumonia.
The patient requires aggressive management and may require admission to the ICU. Respiratory failure requires intubation. Poorly controlled disease may require plasmapheresis.
To read more or access our algorithms and calculators, please log in or register.
